Spine
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A review of the literature concerning the use of interbody fusion devices and materials in anterior cervical surgery. ⋯ There is limited evidence supporting the use of a cervical interbody fusion device in place of autologous bone. There is a need to standardize the testing of implants with good quality laboratory work preceding clinical use. Certain devices including cages, some forms of hydroxyapatite, and bone morphogenic proteins merit further study.
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Randomized Controlled Trial Clinical Trial
Postoperative narcotic requirement after microscopic lumbar discectomy is not affected by intraoperative ketorolac or bupivacaine.
Prospective, randomized, double-blind study. ⋯ Neither ketorolac nor bupivacaine decreased the postoperative narcotic requirement in patients undergoing microsurgical lumbar discectomy. Postoperative narcotic requirements are increased in patients who are in severe pain before surgery, regardless of preoperative narcotic use.
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A study of five patients whose dumbbell or paraspinal tumors of the thoracic spine were managed by using thoracoscopic surgery is reported. ⋯ Combined laminectomy and thoracoscopic surgery may be a good alternative method for managing thoracic dumbbell tumors.
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A nonlinear three-dimensional finite element model of the osteoligamentous L3-L4 motion segment was used to predict changes in posterior element loads as a function of disc implantation and associated surgical procedures. ⋯ The models suggest that, by altering placement of the artificial disc in the anteroposterior direction, a surgeon can modulate motion-segment flexuralstiffness and posterior load-sharing, even though the specific disc replacement design has no inherent rotational stiffness.
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Loads acting in an internal fixator measured in vitro under the application of pure moments such as those commonly used for implant testing and basic research were compared with loads measured in 10 patients in vivo. ⋯ The application of pure moments to intact lumbar spinal specimens in vitro produces forces and moments in implants comparable with loads observed in vivo. During basic research on intact specimens or implant testing involving a removed disc or corpectomy, muscle forces are necessary to simulate realistic conditions.